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Emily Kay-Rivest, Jamie Tibbo, Sarah Bouhabel, Michael Tamilia, Rebecca Leboeuf, Veronique-Isabelle Forest, Michael P Hier, Loren Savoury, Richard J Payne
BACKGROUND: Thyroid nodules are common and often benign, although prove to be malignant upon surgical pathology in 5-15% of cases. When assessed with ultrasound-guided fine-needle aspiration (USFNA), 15-30% of the nodules yield an indeterminate result. The Afirma® gene expression classifier (AGEC) was developed to improve management of indeterminate thyroid nodules (ITNs) by classifying them as "benign" or "suspicious." Objectives were (1) to assess the performance of the AGEC in two Canadian academic medical centres (2), to search for inter-institutional variation and (3) to compare AGEC performance in Canadian versus American institutions...
April 4, 2017: Journal of Otolaryngology—Head & Neck Surgery
Robert P Domingo, Lorna L Ogden, Laura C Been, Giulia C Kennedy, S Thomas Traweek
OBJECTIVES: Parathyroid (PT) lesions can be difficult to recognize in thyroid fine needle aspirations (FNAs), and when not identified correctly, PT cells may be mistaken for potentially abnormal thyroid cells. We therefore studied the utility of combining cytology, immunohistochemistry, and a molecular classifier to identify PT cells in thyroid FNAs. METHODS: Thyroid FNAs were received in CytoLyt, and were evaluated initially using The Bethesda System for Reporting Thyroid Cytology (TBSRTC)...
March 30, 2017: Diagnostic Cytopathology
Sudarshana Roychoudhury, Melissa Klein, Fabiola Souza, Cecilia Gimenez, Alice Laser, Rubina Shaheen Cocker, Karen Chau, Kasturi Das
BACKGROUND: The Afirma gene expression classifier (GEC) is being increasingly utilized to confirm the benign nature of indeterminate FNA cytology results thus avoiding unnecessary surgical procedures. However the "suspicious" result of the Afirma GEC does not classify these indeterminate nodules further in determining appropriate management. This study investigated the outcome of the thyroid nodules deemed to be "suspicious" by the Afirma GEC in a high risk population. METHODS: The pathology database was searched for all thyroid nodules with Afirma test results over a three year period, 2013-2015...
April 2017: Diagnostic Cytopathology
Sylvan C Baca, Kristine S Wong, Kyle C Strickland, Howard T Heller, Matthew I Kim, Justine A Barletta, Edmund S Cibas, Jeffrey F Krane, Ellen Marqusee, Trevor E Angell
BACKGROUND: Thyroid nodules with atypia of undetermined significance (AUS) on fine-needle aspiration (FNA) have a low risk of malignancy that appears to vary based on specific features described in the AUS diagnosis. The Afirma gene expression classifier (GEC) is a molecular test designed to improve preoperative risk stratification of thyroid nodules, but its performance for different patterns of AUS has not been defined. The objective of this study was to assess GEC results and clinical outcomes in AUS nodules with architectural atypia (AUS-A), cytologic atypia (AUS-C) or both (AUS-C/A)...
February 2, 2017: Cancer
Daniela Pirela, Daniela Treitl, Siba El Hussein, Robert Poppiti, Thomas Mesko, Alex Manzano
Water-clear cell adenoma (WCCA) of the parathyroid gland is an exceedingly rare neoplasm. To date, 17 cases have been reported in the literature, with only one of them being intrathyroidal. Here we report a case of a 34-year-old woman who presented for evaluation of a goiter and was found to have a thyroid nodule and abnormal thyroid function tests (TFT). Fine needle aspiration biopsy of the nodule revealed thyroid follicular cells without atypia and subsequent Afirma® Gene Expression Classifier (GEC) testing results were suspicious for malignancy...
2016: Case Reports in Pathology
Xiaoyin Sara Jiang, Grant P Harrison, Michael B Datto
BACKGROUND: Molecular testing provides an important ancillary study for thyroid nodules with indeterminate cytology. The nomenclature shift to "noninvasive follicular thyroid neoplasm with papillary-like nuclear features" (NIFTP) will impact the performance of molecular tests. For the current study, the authors reviewed the performance of the Afirma gene-expression classifier (GEC) and the University of Pittsburgh Medical Center (UPMC) targeted mutation panel tests in thyroid nodules that were subsequently diagnosed as NIFTP on surgical resection...
December 2016: Cancer
Ming Zhang, Oscar Lin
CONTEXT: - Fine-needle aspiration of thyroid nodules is a reliable diagnostic method to determine the nature of thyroid nodules. Nonetheless, indeterminate cytology diagnoses remain a diagnostic challenge. The development of multiplex molecular techniques and the identification of genetic alterations associated with different follicular cell-derived cancers in the thyroid have led to the introduction of several commercially available tests. OBJECTIVE: - To summarize the most common commercially available molecular testing in thyroid cancer, focusing on the technical features and test performance validation...
December 2016: Archives of Pathology & Laboratory Medicine
T Danielle Samulski, Virginia A LiVolsi, Lawrence Q Wong, Zubair Baloch
BACKGROUND: The gene expression classifier (GEC; Afirma-Veracyte) has proven to be an effective triage modality in the management of thyroid nodules. We evaluate our institutional experience with GEC, specifically examining performance as a first line testing strategy versus in conjunction with repeat fine needle aspiration (FNA), usage trends based on clinical setting, and performance related to diagnostic categories of The Bethesda System for Reporting Thyroid Cytology (TBSRTC). METHODS: All nodules undergoing GEC analysis from 1/2011 to 12/2015 at the Hospital of the University of Pennsylvania were identified using electronic database search methods...
November 2016: Diagnostic Cytopathology
Carmen V Villabona, Vineeth Mohan, Karla M Arce, Julia Diacovo, Alisha Aggarwal, Jessica Betancourt, Hassan Amer, Tessey Jose, Pascual DeSantis, Jose Cabral
OBJECTIVE: Thyroid nodules with fine-needle aspiration (FNA) cytology categorized as atypia of undetermined significance (AUS) often undergo additional diagnostic analysis with the Afirma Gene Expression Classifier (GEC), which classifies these as either high probability of being benign (GEC-B) or suspicious for malignancy (GEC-S). Our goal was to assess the clinical validity and utility of GEC in the evaluation of AUS cytology and evaluate the performance of ultrasonography (USG) for predicting malignancy in this subset...
October 2016: Endocrine Practice
Wendy L Sacks, Shikha Bose, Zachary S Zumsteg, Ronnie Wong, Stephen L Shiao, Glenn D Braunstein, Allen S Ho
BACKGROUND: The Afirma gene expression classifier (GEC) assesses malignancy risk in patients with indeterminate thyroid nodules. Afirma putatively reduces costs by classifying certain nodules as benign and thereby avoiding unnecessary surgery. Prior studies have evaluated its impact exclusively on GEC-tested nodules. The objective of the current study was to analyze the effect of Afirma on 1) cytopathology diagnosis, 2) the rate of surgery, and 3) the rate of malignancy on all indeterminate nodules at a high-volume thyroid center...
October 2016: Cancer
Shweta Chaudhary, Yanjun Hou, Rulong Shen, Shveta Hooda, Zaibo Li
OBJECTIVE: The Afirma gene expression classifier (GEC) is a molecular test to further classify indeterminate fine-needle aspiration (FNA) as benign or suspicious for malignancy. STUDY DESIGN: A total of 158 FNAs with Bethesda category III/IV cytology were sent for an Afirma GEC test. We correlated the Afirma GEC results with surgical outcome and also compared the data after Afirma's implementation with the data before. RESULTS: Among the 158 FNAs, the Afirma result was benign in 63 (40%), suspicious in 85 (54%) and unsatisfactory in 10 (6%)...
2016: Acta Cytologica
Kristine S Wong, Trevor E Angell, Kyle C Strickland, Erik K Alexander, Edmund S Cibas, Jeffrey F Krane, Justine A Barletta
BACKGROUND: It is now recognized that noninvasive follicular variant of papillary thyroid carcinoma (NFVPTC) is a distinct subset of FVPTC with an exceedingly indolent clinical course. The Afirma gene-expression classifier (GEC) helps guide clinicians in the management of thyroid nodules with indeterminate fine-needle aspiration (FNA) results. Thyroid surgery is recommended for nodules with a suspicious Afirma result, whereas observation is deemed reasonable for most nodules with a benign result...
July 2016: Thyroid: Official Journal of the American Thyroid Association
Salem I Noureldine, Martha A Zeiger, Ralph P Tufano
No abstract text is available yet for this article.
August 1, 2016: JAMA Otolaryngology—Head & Neck Surgery
Jithma Prasad Abeykoon, Luke Mueller, Frank Dong, Ashish V Chintakuntlawar, Jonas Paludo, Rami Mortada
Thyroid nodules are classified into six cytological categories under the Bethesda classification system. Two of these categories, atypical of undetermined significance (AUS) and suspicious for a follicular neoplasm (SFN), are further labeled as "indeterminate" diagnosis. Starting in June, 2012, Kansas University-Wichita Endocrine clinic implemented Afirma® Gene Expression Classifier (AGEC) to evaluate the need for surgical resection of thyroid nodules in patients with an indeterminate diagnosis. Electronic medical records of patients who underwent thyroid nodule fine-needle aspiration from 2004-2014 were reviewed...
August 2016: Hormones & Cancer
Joseph Singer, John W Hanna, Jay Visaria, Tao Gu, Mark McCoy, Richard T Kloos
OBJECTIVES: The gene expression classifier (GEC, Afirma ) reclassifies as molecularly benign approximately one half of thyroid nodule fine-needle aspiration (FNA) biopsies with an initial indeterminate cytopathology diagnosis, facilitating clinical monitoring in lieu of diagnostic thyroid surgery. This study evaluated the long-term management patterns and thyroid surgery rates of GEC benign patients compared to a control group of cytopathology benign patients and also described the costs of thyroid surgery...
July 2016: Current Medical Research and Opinion
Pablo Valderrabano, Marino E Leon, Barbara A Centeno, Kristen J Otto, Laila Khazai, Judith C McCaffrey, Jeffery S Russell, Bryan McIver
OBJECTIVE: Several molecular marker tests are available to refine the diagnosis of thyroid nodules. Knowing the true prevalence of malignancy (PoM) within each cytological category is considered necessary to select the most appropriate test and to interpret results accurately. We describe our institutional PoM among cytological categories and report our experience with molecular markers. DESIGN: Single-center retrospective study. METHODS: We calculated the institutional PoM for each category of the Bethesda system (Bethesda) on all thyroid nodules with cytological evaluation from October 2008 to May 2014...
May 2016: European Journal of Endocrinology
N Paul Ohori, Karen E Schoedel
Recent advances in thyroid imaging, clinical evaluation, cytopathology, surgical pathology, and molecular diagnostics have contributed toward greater understanding of thyroid nodules. In particular, the development of the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) has brought standardization to the field and the system dovetails well with the implementation of immunohistochemistry and molecular testing to diagnostic practice. Among the molecular strategies available, the application of the molecular panel of common genetic alterations can stratify indeterminate BSRTC diagnoses into low-risk and high-risk groups...
March 2014: Surgical Pathology Clinics
Jennifer A Sipos, Thomas C Blevins, Heidi Chamberlain Shea, Daniel S Duick, Shamsher K Lakhian, Brian E Michael, Michael J Thomas, Julie Ann Sosa
OBJECTIVE: The primary objective was to assess the operative rate in patients with a benign result from the Afirma gene expression classifier (GEC) during long-term follow-up at nonacademic medical facilities. The secondary endpoint of this study was the treating physician's opinion regarding the safety of GEC use compared to the hypothetical situation of providing thyroid nodule management without the GEC. METHODS: This was a retrospective study of nonacademic medical practices utilizing the GEC...
June 2016: Endocrine Practice
Prasanna Santhanam, Rodhan Khthir, Todd Gress, Ayman Elkadry, Omolola Olajide, Abid Yaqub, Henry Driscoll
Prior studies demonstrate that a novel genomic test, the gene expression classifier (GEC), could identify a benign gene expression signature in those nodules with indeterminate cytology with a negative predictive value of greater than 95 %. Examine the performance of the AFIRMA gene expression classifier in predicting benign and malignant nodules in patients with cytologically indeterminate nodules. MEDLINE and EMBASE search for studies meeting eligibility criteria between January 1, 2005, and August 30, 2015...
February 2016: Medical Oncology
Lindsay E Kuo, Rachel R Kelz
Preoperative diagnosis and operative planning for patients with thyroid nodules has improved over the last decade. The Bethesda criteria for cytopathologic classification of thyroid nodule aspirate has enhanced communication between pathologists and clinicians. Multiple genetic tests, including molecular markers and the Afirma gene expression classifier, have been developed and validated. The tests, along with clinical and radiologic information, are most useful in the setting of indeterminate cytology. The development of an updated diagnostic and treatment algorithm incorporating all available tests will help standardize the management of patients with nodular thyroid disease and reduce variation and inefficiencies in care...
January 2016: Surgical Oncology Clinics of North America
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